Claim form for lost or damaged shipments - FedEx

1 Recipient s or Consignee s Name / ContactCompanyAddress State / Province City State / Province ZIP / Postal Code ZIP / Postal CodeFaxFaxSender or Shipper s Name / Contact CompanyAddress City Country PhoneEmailCountry Phone Email I accept that the foregoing statement of facts is hereby certified as correct. DateSignature (for fax or mail) Internal Reference s Name (please print)Claimant s Address PhoneCity State / ProvinceCountry ZIP / Postal CodeE-MailFaxClaim form for lost or damaged shipmentsHouse Bill of Lading or House Airway Bill InformationE-mailShipment Information Loss Complete Partial DamagedPlease retain all packaging and merchandiseuntil your Claim is of packages WeightShip date FedEx Trade Networks Claim number (office use only)Qty of Packages Item No. Item Description Claimed AmountContents of shipmentDescribe damage to outer packagingDescribe inner packagingDescribe damage to contentsDeclared value for customs(International shipments only) $Declared value (The declared value when tenderedto FedEx Trade Networks) $Merchandise value(Original purchase value and/or cost to repair) $ Customer remarksIf your Claim is filed for damage, please note that claimants have a legal obligation to mitigate claims and reduce damage as much as possible.

2 If mitigation through repair or salvage is not possible, please explain why. damaged goods and packaging should be held until the investigation is return the completed form and required proof of loss and value to Proof of loss should include original commercial invoice, packing list, and signed delivery receipt noting exceptions. For damage claims, please include photos of both the damaged packaging and its contents. 31581PL 1/09 FTN update 12/17 SUBMIT